Radiologists' Safety?

[rad86]

This might be a silly question, but what do people in or considering radiology think about the occupational radiation exposure and the related health risks? Is it a significant concern for you?

 

Does the lead you wear reduce radiation to insignficant levels? I suspect it doens't give 100% protection, and over time it can accumulate enough to be harmful...Or do radiologists have limited direct contact with xrays these days? But i imagine with the intenventional stuff you need to work next to the machines. Have there been any studies investigating the long term health risks to radiologists?

 

I know some may say that there're always risks involved for anything, e.g. both ortho and urology need xrays a lot, and surgeons run the risk of cutting themselves, but i'm just wondering if there're better ways in dealing with the issue than ignoring it.

[Ian Wong]

Except during interventional procedures, and fluoroscopic procedures, radiologists spend little time exposed to ionizing radiation. The various types of technologists (ie. xray, CT, nuclear medicine/PET) are the individuals who actually acquire the images, and therefore are more likely to be in the vicinity of the imaging equipment.

 

There are some studies showing that IR docs have an increased risk of developing a certain type of cataract, felt to be related to radiation exposure. However, the lead shielding that is worn does a very good job of reducing exposure to scatter radiation to very low levels. These IR docs who had developed these cataracts had uniformly been in practice for multiple decades, likely before the advent of lead-shielded glasses/goggles.

 

If you are using all your radiation protective equipment, and take steps to minimize exposure (ie. optimizing your imaging technique to minimize dose and stand in positions to avoid the bulk of the scatter radiation), you can drastically cut your exposure levels from what those "old-school" guys used to get. If your dosimetry badges start returning with higher than allowable readings, you will be getting a visit from the friendly radiation safety officer, who will try to figure out what you are doing wrong.

 

The majority of radiologists have a level of radiation exposure that is not much different from the general population.

 

Ian

[rad86]

Thanks Ian for your response! That's good to know

 

A few more questions about radiology, what are the relative proportions of imaging vs. intenventional procedures in the field these days? Do most rads do some combination of both, or can one run a practice only in imaging? And are these patterns projected to change in the future?

[Ian Wong]

It depends entirely on the type of practice that you join. You could have a job doing 100% diagnostic imaging without any patient contact or procedures whatsoever, all the way to 100% interventional/procedures, without any diagnostic imaging.

 

Most radiologists will have a job that intermixes procedures and imaging, generally weighted towards imaging. There are few to no subspecialty areas in radiology that don't have the potential for image-guided procedures.

 

ie:

Mammography: needle localizations, U/S or MR guided biopsies

Musculoskeletal: arthrograms and joint aspirations, US or CT guided tumor biopsies, RFA ablation of tumors, vertebroplasies.

Neuro: Vertebroplasties, cerebral angiography. Neuro-IR will do aneurysm coiling, AVM embolization, thrombolysis, etc.

Body: Abscess drains, biliary drains, thoracentesis, paracentesis, thyroid FNA, lymph node FNA, liver/renal/splenic/pancreatic biopsies.

IR: Catheter/line/port placements, any/all body interventions, vascular and biliary interventions, chemoembolization or RFA of body tumors.

Peds: Lots of fluoroscopic studies requiring physician participation. Potentially may do pediatric procedures.

 

 

Radiologists tend to have a longer practicing lifespan than most other physicians, and there's been no documented increase in cancer incidence. There's even a theory called radiation hormesis, which (although not widely held) states that some exposure to very low levels of radiation can be protective, by stimulating clearance of cells that may be partially dysplastic.

 

Personally, I am much worried about exposure to blood-borne diseases like HIV and Hep C than I am about radiation exposure. We get needle-sticks in radiology, and there's the potential for blood to spray around if you are doing IR and a wire or catheter uncoils on you. As well, in the OR, patients are usually under general anesthesia and are completely out. If you are doing procedures under local or conscious sedation, patients can still move around, and that's always scary if you've got a needle or scalpel in your hand.

 

Ian

[rad86]

Thanks Ian for your informative post once again.